A panic attack is a sudden, intense wave of fear that peaks within minutes, often with a racing heart and chest tightness severe enough to feel like a heart attack. An “anxiety attack” is not a clinical term. It usually means anxiety that builds gradually around a specific worry and fades once that worry passes.
Your heart is pounding, your chest feels tight, and part of you is wondering whether you should call someone. Or maybe it built up slower: a knot that got tighter through the afternoon until you could not focus on anything else. Both feel like an emergency. Only one of them is a phrase psychiatrists actually use.
What a Panic Attack Feels Like (and Why It Gets Mistaken for a Heart Attack)
A panic attack does not build. It arrives. The DSM-5-TR describes it as an abrupt surge of fear or discomfort that peaks within about ten minutes, often with no clear trigger at all. You can be sitting still, half asleep, or halfway through an ordinary conversation when it starts.
Four or more of these symptoms usually show up together:
- A racing or pounding heart
- Chest pain or tightness
- Shortness of breath, or a choking feeling
- Sweating, trembling, or sudden chills
- Nausea or stomach distress
- Dizziness or feeling faint
- Numbness or tingling in the hands or face
- A sense of unreality, like watching yourself from outside your body
- Fear that you are losing control, or fear that you are dying
That last pair of symptoms explains a pattern doctors see constantly. Studies reviewed in the Journal of the American Board of Family Medicine put the rate of undiagnosed panic disorder at an estimated 18 to 26 percent among patients evaluated in emergency departments for chest pain. In plain terms, roughly one in five to one in four people rushed in for a suspected heart attack are, once the tests come back clear, actually having a panic attack.
This shows up before anyone says the word “anxiety.” In South Asian clinical settings especially, the physical sensation almost always gets named first: a racing heart, a tight chest, a feeling that something in the body has gone wrong. The psychological label, if it arrives at all, comes later.
What an “Anxiety Attack” Feels Like (and Why the Term Confuses People)
Here is the part most articles skip past: “anxiety attack” is not in the DSM-5-TR. Clinicians will not find it in the manual they diagnose from, because it was never added as a formal diagnosis. People use the phrase anyway, and it usually points to one of two things: a bad stretch of generalized anxiety, or a panic attack described in everyday language.
When someone describes an anxiety attack, the symptoms tend to build instead of explode:
- Persistent worry that will not switch off
- Muscle tension, restlessness, or feeling constantly on edge
- Irritability or trouble concentrating
- Sleep that will not come, or comes and does not stick
- A tight, heavy feeling that grows across hours instead of hitting in one wave
The instinct is to treat this as a smaller version of a panic attack. That is not quite right. It is a different shape of the same nervous system response: stretched out instead of compressed, tied to an identifiable worry instead of appearing out of nowhere.
Panic Attack vs Anxiety Attack at a Glance
| Panic Attack | “Anxiety Attack” | |
|---|---|---|
| Onset | Sudden, often with no warning | Gradual, over hours |
| Peak | Within about 10 minutes | No fixed peak, can plateau |
| Duration | Usually resolves in 20 to 30 minutes | Can last hours, sometimes longer |
| Trigger | Frequently none | Usually a specific, nameable stressor |
| Clinical status | Defined in the DSM-5-TR | Not a formal diagnosis |
| Physical intensity | Severe, often mimics cardiac symptoms | Present, usually milder |
Treat this table as a rough compass, not a diagnostic tool. Real episodes overlap these categories more often than any table can show.
How People Describe It in Urdu, Long Before Anyone Says “Anxiety”
English mental health vocabulary does not map cleanly onto Urdu or Punjabi. There is no single, comfortable word for “panic attack” that most patients reach for first. What comes out instead is a description of the body.
“Dil ghabra raha hai” (the heart feels unsettled, restless) is one of the most common. “Dil doob raha hai” or “dil dub gaya” (the heart is sinking) is another, closer to dread than to a racing pulse. “Sans phool rahi hai” describes the breathlessness. “Ghutan ho rahi hai” is the choking, suffocating feeling. Some people describe their hands and feet going cold, or their mind going completely blank.
None of these are clinical terms, and this article is not turning them into one. But researchers studying South Asian communities have documented this pattern for decades.
A well-known 1989 paper on Punjabi patients in the UK described “sinking heart” as a genuine idiom of distress: a culturally specific way of expressing what Western psychiatry would file under anxiety, panic, or sometimes depression, built around the body rather than the mind. Its central argument still holds. Much of the English vocabulary used for anxiety, panic, and depression simply does not exist in the same form in South Asian languages, so people describe the sensation instead of naming a condition.
The practical upshot: if you have been telling a doctor about your heart or your breathing for months without anyone mentioning anxiety, you are probably not describing the wrong thing. You may just have been describing it correctly, in a language that does not hand you the psychiatric label for free. Naming the physical sensation is enough to start a conversation with a psychologist. You do not need the English vocabulary to justify it.
Common Mistakes People Make
Treating every episode as a fresh cardiac emergency. A first attack should always be checked by a doctor. Repeated attacks with clear ECGs and normal blood work almost never need another ER trip. Ask your doctor at that first visit exactly what to do the second time, so you are not stuck making that call alone at 2 a.m.
Calling it “just stress” and waiting it out. Ordinary stress does pass on its own. Attacks that keep recurring, or that leave you dreading a repeat, are the body flagging a pattern worth actual treatment. Waiting rarely makes a recurring pattern disappear by itself.
Rearranging your life around avoidance. Skipping the restaurant where it happened once, driving instead of taking the metro, always sitting near the exit: each choice feels small on its own. Together, they shrink the world a person is willing to move through, and that shrinking is exactly how panic disorder and agoraphobia take hold.
When to Get Help
See a doctor the first time, always, before assuming anything. Chest pain and breathlessness deserve a real medical check, not a guess. Once a doctor has ruled out a cardiac or medical cause, these signs suggest it is time to bring in a psychologist rather than keep managing it alone:
- Attacks are happening more than once a month
- You have started avoiding places, people, or situations because of them
- You spend real time and energy worrying about when the next one will hit
- Sleep, work, or relationships are visibly suffering
- Someone close to you has said something
That last one is worth taking seriously. People often notice the shrinking world before the person living in it does.
CureOnCall’s online therapy for anxiety and stress is built around exactly this: a structured, assessment-led approach with Psy. Hijab Zehra, MPhil Clinical Psychology, rather than generic breathing advice. Sessions run over confidential video consultation, for clients in Pakistan and abroad.
Frequently Asked Questions
Speed is the clearest clue. A panic attack hits within minutes and usually peaks and fades inside half an hour. An anxiety episode builds gradually around a specific worry and can drag on for hours. If it came out of nowhere and hit hard fast, lean toward panic attack.
Sit or lean against something solid so your body is not also managing balance. Breathe out longer than you breathe in, roughly four counts in and six counts out, since that slows your heart rate faster than deep breathing alone. Name five things you can see, four you can hear, three you can touch. It will peak and pass within minutes.
No, and it is not something to just live with. One or two attacks in a lifetime are common and not automatically a disorder. Daily attacks usually mean panic disorder has developed, which responds well to therapy. Treat this as a signal to book an assessment, not a personality trait.
Panic attacks are more physically intense in the moment and more likely to send someone to an ER. Anxiety episodes last longer and can wear a person down over hours or days. Neither is worse across the board. It depends on which one is happening to you right now, and how often.
Yes, to a degree. Caffeine, alcohol, and poor sleep can all lower the threshold for an attack, and cutting back on caffeine in particular helps some people notice fewer episodes. None of this replaces therapy for someone having recurring attacks. Lifestyle changes lower the volume. They do not solve the underlying pattern.
The Next Attack You Have
You will probably have another one, or you will watch someone you love go through one. When that happens, the name matters less than what you do next: get the first episode checked by a doctor, notice whether it is building or bursting, and stop treating repeated episodes as something to just push through. That is the difference between managing an attack and eventually not having many left to manage.
Sources
- National Institute of Mental Health, Panic Disorder statistics
- StatPearls / NCBI Bookshelf, Panic Disorder
- Cleveland Clinic, Panic Attack vs. Anxiety Attack
- Journal of the American Board of Family Medicine, Panic Disorder and Coronary Artery Disease
- Krause, I-B. (1989). Sinking heart: a Punjabi communication of distress. Social Science & Medicine.
This article is educational and does not replace a medical or psychological assessment. If you have chest pain or breathlessness that has never been checked by a doctor before, treat it as a medical emergency first.
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Hijab Zehra is an MPhil-qualified clinical psychology professional with an academic background in mental health, emotional wellbeing, behavioural patterns and psychological assessment. Her work focuses on helping individuals understand anxiety, mood changes, stress responses, emotional regulation and the psychological factors that affect daily functioning. Through CureOnCall, she contributes to patient-friendly mental health content that explains complex psychological concerns in a clear, practical and supportive way.
